Three-month mortality in permanently bedridden medical non-oncologic patients. The BECLAP study (permanently BEdridden, creatinine CLearance, albumin, previous hospital admissions study)

Objective:Topredictthe3-monthsmortalityinpermanentlybedriddenmedicalnon-oncologicinpatients.PatientsandMethods:2788consecutivepatientsadmittedin5ItalianInternalMedicineunitsfromJanuary2016throughJanuary2017wereprospectivelyscreened;644 oncologic patients were excluded; 2144 non-oncologic patients (1021 female) were followed-up for mortality for 6 months. Main outcome was 3-monthsmortality in permanently bedridden inpatients with at least 2 of: creatinine clearance<35ml/min; albumin < 2.5g/dl; at least 2 hospital admissions in theprevious6months.Advanceddementiaanddysphagiawerealsorecorded.Results:Meanageofthe2144patientswas73.9(SD,14.9)years;374(17%)werepermanentlybedridden,435(20%)hadacreatinineclearance<35ml/min,217(10%)albumin <2,5g/dl,112(5%)atleast2hospitaladmissionsintheprevious6months.Seventy-seven(4%)patientswerepermanentlybedriddenwithatleast2oftheabovementioneditems,and48ofthemdiedwithin3months(62%)(p< 0.001;95%CI51–73%).Regressioncoefficientsofthevariablesassociatedwith3-monthsmortalityinmultivariateanalysisin998patientsofunit1(trainingcohort)wereusedtocreateasimplescore,whichwasvalidatedinthe1146patientsoftheotherunits(validationcohort)andperformedwellinpredictingthe3-monthsmortality(https://www.ejcrim.com/beclap/).Conclusions:Approximatelytwooutofthreenon-oncologicmedicalpatientspermanentlybedriddenhaving2oftheabovementioneditemsaredead3monthsafterindexadmission;asimplescoreincludingbedriddenstatus,creatinineclearance,albumin,dysphagia,ageandsexmayhelpdiscussmanagementpriorities.